Osteoporotic spinal compression fractures

Osteoporotic spinal compression fractures are associated with significant performance impairments in physical, functional, and psychosocial domains.

Most are isolated fractures of the anterior spinal column related to low bone mineral density.

Postmenopausal women and patients taking long-term corticosteroid therapy are most susceptible.

The causative mechanism is a combination of flexion and axial compression loading.

It is important to exclude the possibility of pathologic fracture due to malignancy or infection.

Most patients are successfully treated with conservative methods. Analgesia is prescribed to reduce pain and encourage mobilization. After an initial short period of bed rest, mobilization should be encouraged. Select patients may benefit from temporary use of an orthosis.

Surgical intervention may be required for patients who develop severe unrelenting pain or significant deformity, or for potentially unstable acute fractures. The main surgical options are vertebroplasty, kyphoplasty, or open surgical stabilization or reconstruction.

Radiographic and clinical follow-up is required every 6 weeks for 3 months post-injury.

Most osteoporotic spinal compression fractures represent an isolated failure of the anterior spinal column due to a combination of flexion and axial compression loading. The stability of the spine is not compromised with this type of fracture. These fractures are traditionally considered benign injuries that heal without complications.[1]Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine: current options and considerations for treatment. Spine J. 2006 Sep-Oct;6(5):479-87. http://www.ncbi.nlm.nih.gov/pubmed/16934715?tool=bestpractice.com Rarely, osteoporotic compression fractures can also involve the middle and/or posterior spinal columns, in addition to the anterior column. This type of fracture is potentially unstable and requires surgical intervention.[Figure caption and citation for the preceding image starts]: Lateral radiograph showing a T12 compression fracture in osteoporotic bonePersonal collection of Nasir A. Quraishi [Citation ends].​​​[Figure caption and citation for the preceding image starts]: Burst fracture with large retropulsed fragment in spinal canal. The patient underwent posterior decompression and stabilizationPersonal collection of Nasir A. Quraishi [Citation ends].[Figure caption and citation for the preceding image starts]: Vertebral fracture-dislocation. The patient underwent posterior decompression and instrumented stabilizationPersonal collection of Nasir A. Quraishi [Citation ends].